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Good day, and thank you for standing by. Welcome to the Neuronetics first quarter 2026 financial and operating results call. At this time, all participants are in listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star one one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today.

Good morning, thank you for joining us for the Neuronetics first quarter 2026 conference call. Joining me on today's call is Neuronetics President and Chief Executive Officer, Dan Reuvers. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

For a discussion of risks and uncertainties associated with Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed in March, and the company's quarterly report on Form 10-Q for the quarter ended March 31st, 2026. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA and adjusted EBITDA. Management believes that non-GAAP financial information taken in conjunction with U.S. GAAP financial measures provides useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results.

Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it's my pleasure to turn the call over to Neuronetics President and Chief Executive Officer, Dan Reuvers.

Thanks, Mark, and welcome everyone to our first quarter 2026 earnings call. I'll begin by sharing some perspectives on my background and why I joined the company, discuss some early observations, I'll walk through the key drivers of our performance in the quarter. I'll walk through our quarterly financial results in greater detail, I'll conclude with my perspective on the rest of 2026 before opening the line for questions. This is my first earnings call as CEO of Neuronetics, I'm pleased to be here. I've spent about 35 years in the med tech industry, Most of my career has been in businesses where patient impact, execution, and operational rigor drive the outcome. Most recently, I served as CEO of Tactile Medical, where we grew revenue from $187 million to approximately $300 million.

During that time, we expanded patient reach, grew gross margins, delivered record earnings, and cash flow generation. Before that, I spent 12 years with Integra LifeSciences, where I led the $1 billion Codman Neurosurgery Division. Earlier in my career, I held leadership roles at several other med tech companies. There were a couple things that drew me to this role. First, our mission to renew lives by restoring hope for patients and their families is one that I'm passionate about. It's amazing how many people have reached out to me since taking the role, sharing their stories of how they or someone they knew have either suffered from depression or, better yet, benefited from one of our therapies. Second, I think my background gives me a great perspective on how to move this business forward.

My experience in the device space will allow me to come up to speed on the NeuroStar business quickly, and it's notable that Tactile was vertically integrated, meaning we designed, manufactured, and sold our therapy solutions, but also directly billed third-party payers, an experience I expect to draw on as we continue to improve efficiency within our Greenbrook clinics. Since stepping into the role, I've spent the bulk of the last month on a listening tour. I've been on the road with our field team, inside our clinics, and meeting with customers. I've also engaged with shareholders, analysts, and others, helping me shape my understanding of the business. My approach has been deliberate and comprehensive, intended to allow me to fully understand this business before making decisions about where to lean in, where to adjust, and how we maximize the value of what we have.

With that said, what I've seen in my first few weeks has reinforced my conviction in the underlying opportunity that exists for us. First, on the NeuroStar side, I see a clear opportunity to broaden how we go to market and reach customer segments where we've not historically been positioned to compete. I'll talk more about that in a moment. Second, with the Greenbrook clinics, workflows are key to optimizing profitability in our clinics, not only ensuring that patients have an efficient path to initiate their treatment and gain relief, but also to minimize operational handoffs. Revenue cycle management is also an area where I've spent time in my previous role, and what I've seen inside our clinic operations tells me there is more opportunity ahead.

Lastly, we have a talented team that's focused and executing, and I've been genuinely impressed with the quality of the people and the conviction toward our mission across the organization. Before I walk through the quarter, I'd like to briefly address two items. First, on our recently announced CFO transition. Steven Pfanstiel departed earlier this month to pursue an opportunity outside Neuronetics. We've initiated a comprehensive search to identify his successor. We appreciate Steve's contributions during his time at Neuronetics, and we'll provide updates as the search progresses. Ultimately, this allows me to select a partner that I'm confident can help me lead our next chapter. Second, I want to share some perspective on the comments made by certain shareholders about our business.

While we believe that the integrated NeuroStar and Greenbrook businesses provide us with a strong foundation to grow from, we respect some shareholders' views that the separation of the business could potentially unlock shareholder value. The board and I are aligned on operating this business with discipline and on making decisions that create long-term value for our shareholders. I assure you that I'm evaluating this business with an open mind, and I appreciate everyone's patience as I work through my process. With that context, let me share a bit more about our performance in the quarter. Our Q1 results were largely in line with expectations, and we're making progress on the commercial and operational priorities already in motion. Starting with the NeuroStar business. During the quarter, we shipped 34 systems, up 10% year-over-year.

We continued to support our installed base with the most comprehensive training and clinical resources in the category. We're also modernizing how we deliver that support with more virtual, on-demand, and real-time engagement tools that provide customers with choices on how they want to be supported. We're piloting an expanded set of commercial models for NeuroStar. Customers exist with a range of needs, and while we have a history of providing unparalleled ongoing support to our customers, we also know that not all customers' needs are the same. Expanding our go-to-market menu is a priority. I'm convinced that we can compete on a broader horizon by listening to customers and responding in kind. Early feedback's been positive, and I'll have more to share in August. Now, a few comments on Greenbrook. Clinic revenue grew 15% in the quarter.

Growth in the quarter was driven by continued strength in SPRAVATO with treatment growth year-over-year and expansion of buy and bill. On the TMS side, within our clinics, volumes were modestly below prior year levels in the quarter, which we attribute in part to weather disruption across portions of our footprint during the first two months of the quarter. We saw patient flow normalize as the quarter progressed, and we expect to return to more typical volume trends as we move into the second quarter. Within our clinic operations more broadly, the focus remains on workflow and revenue cycle management. The team has made real progress on collections and operational efficiency, and we see continued runway. We've also leveled our marketing investment across the year rather than front-loading it, which we believe is the right cadence for the business.

We acted during the quarter to better align our cost structure. These steps are expected to deliver annualized savings of approximately $2.5 million to $3 million with net savings beginning in the third quarter. Profitability and cash are top priorities and will be a focus of mine going forward. Taken together, the quarter reflects a business that's executing on the priorities already in motion while we lay the groundwork for our next phase of growth. With that, I'll walk through the financial results in greater detail. Unless otherwise noted, all performance comparisons are being made to the first quarter of 2026 versus the first quarter of 2025. Total revenue in the first quarter was $34.5 million, an increase of 8% compared to revenue of $32 million in the first quarter of 2025.

The increase in revenue was primarily driven by higher U.S. clinic revenue. Total revenue from our NeuroStar business, inclusive of our system revenue, as well as treatment session revenue, was $12.9 million in the first quarter of 2026. This represents a decrease of 3% versus the prior year. U.S. NeuroStar system revenue was $3.2 million, an increase of 13% on a year-over-year basis. We shipped 34 systems in the quarter, an increase of approximately 10% versus the prior year. U.S. treatment session revenue was $9.1 million, a decrease of 5%. While system treatment utilization increased 3.5%, this was offset primarily by a reduction in customer inventory levels. U.S. clinic revenue was $21.5 million, a 15% increase year-over-year.

The results were driven by continued strong SPRAVATO growth and overall pricing improvement. Gross margin was 46.9% in the first quarter of 2026 compared to 49.2% in the prior year quarter. The decrease in gross margin is a result of revenue mix, with clinic revenues representing a higher portion of our overall revenues. We also saw some negative impact from the increase in SPRAVATO buy and bill from Q1 of last year when we were still launching that offering. Operating expenses during the quarter were $25.1 million, a decrease of $1.6 million or approximately 6% compared to $26.8 million in the first quarter of 2025. The decrease is primarily attributable to savings in SG&A expenses, where we have driven and will continue to drive efficiencies.

Net loss for the quarter was $10.8 million, or $0.16 per share, as compared to a net loss of $12.7 million or $0.21 per share in the prior year. First quarter 2026 adjusted EBITDA was -$6.6 million as compared to -$8.6 million in the prior year, an improvement of $2 million. Moving to the balance sheet and cash flow. As of March 31st, total cash was $19 million, consisting of cash and cash equivalents and restricted cash, as compared to $34.1 million as of December 31st. Cash used by operations in the first quarter was $9.4 million. This compares to an operating cash use of $17 million in Q1 of 2025, an improvement of $7.6 million versus the prior Q1.

As previously disclosed, in March 2026, we amended our debt agreement with Perceptive Advisors, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a one-time principal payment of $5 million to Perceptive Advisors, along with adjustments to the existing debt covenants. Turning to guidance, which remains unchanged. We continue to expect total revenue between $160 million and $166 million. Gross margins to be between 47% and 49%. Operating expenses in the range of $100 million-$105 million, inclusive of approximately eight and a half million dollars of non-cash stock-based compensation. Cash flow from operations between -$13 million and -$17 million.

As a reminder, our operating cash flow is projected to improve beginning in the second quarter and then sequentially through the remainder of the year, with operating cash flow being flat to positive during the second half of the year. In the second quarter, we expect to see mid-single-digit growth. As we look ahead to the remainder of 2026, our priorities are clear. We're focused on disciplined execution, sharpening how we go to market, and continuing to drive the business towards being cash flow positive. The pilots we have underway in the NeuroStar side of the business are designed to expand our reach, and within our clinic operations, we'll continue to focus on workflow, collections, and operational efficiency. We expect these benefits to continue building throughout the year. Looking further out, I want to briefly touch on Compass Pathways' pending psilocybin therapy.

The regulatory process is Compass Pathways' to navigate. The Trump administration's recent executive order prioritizing such submissions is certainly encouraging. If approved, we believe Greenbrook TMS is among a very small number of providers genuinely equipped to deliver it. The protocol requires certified settings, trained clinical staff, and a proven back-office infrastructure for benefits investigation and prior authorization, all of which we already have in place through our SPRAVATO operations. While we will be prepared to execute if the product is approved, similar to SPRAVATO, we'd expect the revenue ramp to be measured in the first year of launch. The narrow pool of providers capable of delivering this therapy represents a durable advantage for our business. As I mentioned earlier, my approach in these first few weeks has been deliberate. I'm committed to making decisions that balance the interests of our patients, physicians, colleagues, and shareholders.

I expect to be able to share an even more grounded view of where we're headed when we report next quarter. I want to thank the Neuronetics team for the work they've put in this quarter and for the welcome they've given me. I look forward to updating you all on our progress in August. With that, I'll open the call for questions. Operator?

Thank you. At this time, we will conduct the question and answer session. Our first question comes from the line of Bill, sorry, Bill Plovanic from Canaccord Genuity. One moment while I bring him to the stage.

Hello. Good morning. Can you hear me?

Bill, your line is now open.

Yeah. Morning, Bill.

Okay, great. Good morning. Yeah. Okay. Thank you. Three questions for you, Dan, if I could. One is just clarity on the performance in the Greenbrook sites. I just wanna make sure I heard that, was it the treatment revenue and number of treatments was down year-over-year backing out the SPRAVATO? I just want to get to make sure I heard that correctly.

Overall, we were pleased with the Greenbrook performance. We were up double digits, as we said, about 15%. The TMS volumes were off a little bit, Bill. We think that that was related to a couple things. One, weather, which we, you know, pretty concentration up here in the Northeast. We were a little lumpy in our ad spend as we exited last year. Smoothing that this year I think is gonna bring that more in line with consistency. We also saw better performance in March than we did in January and February. Was, you know, we don't think that that was a trend as much as an event.

On the SPRAVATO side, we saw growth in both the buy and bill and the A&O segments, double-digit in both segments. Yet buy and bill was up as a mix compared to Q1 of last year, but I think it's worth noting that we've also seen that kind of equilibrate over the last couple of quarters as far as mix between that and A&O.

Okay, great. Then, thank you for that. Then just secondly, you know, one of the biggest challenges, you know, new executives face when they come into a company is just making sure to keep the team intact, and turnover. I just wanted to see if you could provide any color on, you know, what you've seen thus far. I know it's only been 45 days, but, just kind of what you've seen across the organization thus far.

Yeah. Yeah. First of all, I've been really impressed with how much the mission permeates through the company. People are really connected with the impact that we're making on patients' lives. I mentioned in my opening comments that I've been on a listening tour for the first month for the most part, and that gave me an opportunity to go out and spend time with folks in the field, as well as having spent a good amount of time in the office. I've met with a lot of people, have been trying to connect as best I can with things like podcasts and town halls. So far, I've been pleased with, as I said, kinda where people's attitudes are.

I think there's an anxious enthusiasm to think about how we might do things different, how we might continue to find ways to get better. Overall, I would say quite good. I haven't seen anything, as far as turnover spikes or anything that would've, I would say, raised an eyebrow for me.

Okay. I think just the last question is really the elephant in the room. I mean, you addressed it, but I just wanted to hit home on it. Just, you know, you ended the quarter with $19 million in cash, $13 million unrestricted. You know, it sounds like, you know, given the guidance that would tell us you'll use $4 million-$8 million of that during the full year. I would expect most of that would be in the second quarter given, you know, the guidance that the back half would be positive. I just, you know, any thoughts, comments, is that enough to get you through with working capital, and just how are you thinking about that today? Thanks for taking my questions, Dan.

Yeah. Yeah. I mean, we're always evaluating the balance sheet, but I think as we shared, at the midpoint of $15 million of burn for the full year, the math would lead you to $14 million at year-end. You know, you're also right in that our assumptions are that we would be flat to positive in the second half of the year. You know, based on the current, current plan, we feel like we've got sufficient headroom in the balance sheet to take us through the year.

Great. Thanks.

Thank you. Our next question comes from Adam Maeder of Piper Sandler.

Good morning.

Your line is now open.

Hey, Dan. Hopefully you can hear me okay. Congrats on the new role, and look forward to working with you again. Two from me, one kind of housekeeping question and one bigger picture question. Just on the housekeeping item, you know, weather, it sounded like there was an impact to TMS volumes at Greenbrook clinics. Was hoping you could kind of quantify that for us. Is it also reasonable to assume that your standalone NeuroStar business also saw some headwind from weather? You know, how do we think about how quickly these patients can potentially kind of be, their sessions can be recaptured? I had a follow-up. Thanks.

Yeah. Not gonna quantify on the Greenbrook side, Adam, we do think that there was some of the impact there, particularly because we saw more of the weakness in January and February than we did in March. It's also worth noting on the NeuroStar side that TMS patients are coming in every single day. Trying to manage a schedule around weather is more difficult than SPRAVATO patients that are coming in more episodically and have a lot more latitude in scheduling. I think that was one of the reasons that we saw the impact within Greenbrook. On the NeuroStar side, we think that we saw, you know, some of the same kind of impact from weather.

That said, from a total utilization standpoint, we were actually up low single digits on absolute utilization within our NeuroStar business as far as treatment sessions were concerned. We saw a little softness in the revenue rec just because we had a little bit of customer inventory on hand that folks are working through. Overall, you know, I would say the business held up quite well in spite of the weather.

Okay, fantastic. And then for my follow-up, you know, Dan, in the press release, you talked about significant value in the business that's yet to be fully realized. You also have a large shareholder who issued a letter last month for asking for a strategic review and potentially a sale of the TMS business. You know, you touched on it in the prepared remarks. I think I heard you're evaluating the business with an open mind. I guess I was hoping you could share a little bit more color here on your early learnings and thoughts as you think about kind of the broader makeup of Neuronetics.

You know, one question that I sometimes get from investors is, you know, the NeuroStar business, the standalone business, why can't that business grow faster given the size of the total addressable market and what are the plans to kinda catalyze that business? Sorry for the multi-part question.

No problem. First, as it relates to the shareholder letter that we saw, you know, as I said in my opening remarks, I mean, I really have been on a listening tour, and I've had outreach to that shareholder along with others, just to make sure that I'm hearing some of their thoughts and concerns. You know, I think there's some frustration there, and quite frankly, I appreciate it. I think that what I'm still trying to do is really look at the business through a variety of different lenses, and I'm pretty pragmatic about it. I mean, I'm not wed to a predetermined conclusion, but I'm also not inclined to be impetuous and make sure that I look at the business overall.

I think as it relates to what can we do to continue to demonstrate strength and growth, which under any outcome scenario adds long-term value for shareholders, it's, you know, looking at the NeuroStar business, I do think that we've probably underpunched our weight here lately. The opportunity to expand our go-to-market menu is one of the things that I believe is gonna be a helpful catalyst for us. We're still in pilot phases on that, Adam, but, you know, ultimately, we have taken an approach that has conveyed what I would call unparalleled support to our TMS customers. I don't think any other competitor out there comes even close to the kind of support we provide to our customers. That said, not all customers' needs are the same.

I think it's important for us to expand our menu and allow customers to kind of establish which parts of value they want and make sure that we've got kind of a broader berth of go-to-market menus that they can select from. We're in the midst of doing some pilots right now. I think, you know, we'll have a lot more clarity over the next couple of months. It includes making sure that we're looking at incentive comp, that it's aligned with our direction, that we have an opportunity to revisit our funnel and make sure that, you know, we've slotted those in the right in the right spaces.

More work to do, but I think that as we continue to really reevaluate our go-to-market and with an open mind, look at how we can make sure that we're matching the right level of support to that which the customer wants to pay for, I think that's, you know, that's a ratio that I expect will bear some fruit.

Thank you.

Thank you. Our final question comes from the line of Danny Stauder of Citizens JMP. Your line is open.

Yeah, great. Thanks for the questions. Just, my first one, following up on kind of the TMS question, Dan, I wanted to ask about the commercial strategy for TMS. We know there was a realignment of the capital sales team. System sales have been strong the last two quarters. As you sit here in the early days of year 10, tenure, just broadly, how do you think about the balance between focusing on driving utilization per site versus expanding the install base? Are there any potential strategic changes here or, you know, how do you think about that balance?

I think continuing to drive utilization is an important one, because whether we're on a sessions model or otherwise, it's what's the underlying creation of demand. The more utilization, our customers continue to find more patients they can help, one way or another, that's gonna lead to an expansion of our business. I think we're, you know, we're gonna continue to look to how we can expand our socket placement, or our placement of new capital units. I think that's one of the places where we've probably slipped a bit. Focusing on new placements and expansion of capital, and making sure that it's our unit that resides in those clinics, regardless, I guess, of what economic model is in place, we just wanna make sure that we're demonstrating the most value across the competitive landscape.

I think that, you know, between the support we provide with our account managers in the field, with benefits investigation, our co-marketing, training, service, the cloud-based TrakStar utility that we've got, I just don't think anybody can compare there. You know, we're gonna, as I said, continue to work through a couple of pilots. The things that got us there, I think, will continue to be durable areas of value. How we structure that, I think, is some of the things that we're still titrating a bit.

Great. Appreciate that. Just one on the Compass collaboration. You know, obviously, the recent update from the administration is good news. I just wanna get a sense of how meaningful this could be. Obviously, Compass is already pretty far along in terms of the approval process, but do you feel this recent update could be more important on the reimbursement pathways? I know that's been a focal point for eventual contribution. Just any thoughts you have there would be appreciated.

Yeah. Well, first of all, I think that the whole Compass opportunity and psychedelics at large represent a big opportunity for us, given our footprint and our infrastructure. I was really excited in my first month to see the Trump executive order leaning into the FDA process on some of these. I think that it probably shortens the fuse. How much, I don't know, it probably shortens the fuse on the path to approval, which I think is encouraging for all of us that are in this space. I'm not sure how much it impacts reimbursement. I think that's probably a separate track, certainly the pursuit of that in tandem on Compass' behalf, all of those things sort of point to faster than slower.

And, you know, as we get into 2027, we'll certainly look forward to being able to try and better quantify what we think that means to us. I think if you look at the SPRAVATO rollout from the early days, as much enthusiasm as there was, it's a bit measured in its early adoption. I think that the momentum is certainly moving in the right direction on this one.

Great. I appreciate that. Just one last one from me. I just wanted to ask on some of the TMS coverage expansion to include nurse practitioners. I was just curious at, you know, high level, if there have been any incremental conversations with accounts on this topic. Have you seen that customers are waiting for this, maybe some with higher demand? Just anything more on how this could impact utilization and how you think it will play out in 2026 and beyond would be great. Thank you.

Yeah. That's the reference to the UnitedHealthcare and the Optum coverage policy change, where nurse practitioners can now be eligible to deliver TMS versus licensed psychiatrists. I think it's a good move. We got a lot of really quality nurse practitioners caregivers out there. I don't know that they were waiting for it as much because maybe they didn't, sometimes you never know if it's ever coming. There are 35 million covered lives in the 26 states that'll be affected. I think what it will allow us to do, or has allowed us to do, is go revisit some of those clinics that are managed by nurse practitioners where TMS just wasn't a viable option because of the reimbursement limitations.

You know, I think it probably added, a number of accounts to our target list, but, still early days since we're, I think, a month in.

Great. Appreciate the questions.

Yep. Thank you.

This concludes the question and answer session. I would now like to turn it back to Dan Reuvers for closing remarks.

Yeah, I just wanted to thank all of our employees for a hard-fought quarter, as they all are, as we continue to try and restore hope to patients and their families. Wanted to thank our shareholders for their support, and I look forward to sharing an update on our progress when we have an opportunity to share the results of our second quarter. Thank you.

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.

Ladies and gentlemen, thank you for standing by, and welcome to the Neuronetics, Inc. Reports Fourth Quarter 2025 Financial and Operating Results. At this time, participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. To ask a question during this session, you will need to press 11 on your telephone. You will then hear an automated message confirming your hand is raised. To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to turn the conference over to Mark R. Klausner. Sir, please go ahead.

Good morning, and thank you for joining us for the Neuronetics, Inc. Fourth Quarter 2025 Conference Call. Joining me on today's call are Neuronetics, Inc.'s President and Chief Executive Officer, Keith J. Sullivan, and Steven E. Pfanstiel, Neuronetics, Inc.'s Chief Financial Officer. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the Greenbrook integration, and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business. For a discussion of risks and uncertainties associated with Neuronetics, Inc.'s business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's Annual Report on Form 10-K, which was filed premarket today. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. During the call, we will also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information, taken in conjunction with U.S. GAAP financial measures, provides useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results. Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans, to benchmark our performance externally against competitors, and for certain compensation decisions. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it is my pleasure to turn the call over to Neuronetics, Inc.'s President and Chief Executive Officer, Keith J. Sullivan.

Thanks, Mark. Good morning, everyone, and thank you for joining us today. Before I get into our results, I am pleased to announce that the Board has appointed Dan Reavers as our next President and Chief Executive Officer of Neuronetics, Inc., effective March 23. Dan is a proven leader with more than 30 years in medical devices, and he knows how to build and scale commercial health care businesses. Having spent time with Dan through the search process, I am confident he is the right person to lead the company into the next chapter, and I am looking forward to working with him to ensure a smooth transition. Now turning to our performance. A little over a year ago, we closed the Greenbrook acquisition and set out to build a vertically integrated mental health company with the technology, the clinical infrastructure, and the scale to fundamentally change how patients access treatment for mental health conditions. I am proud to say that in our first full year as a combined company, we have done exactly that. We delivered strong fourth quarter results with adjusted pro forma revenue growth of 23%, driven by our strongest capital shipment quarter of the year and continued momentum across our Greenbrook clinic network. We also achieved the key milestone of positive operating cash flow in the fourth quarter, driven by revenue growth, operational discipline, and the cash collection improvements that we have been implementing throughout the year. Starting with the update on Greenbrook. Over the course of 2025, we executed against our growth initiatives, and the results speak for themselves. Full-year clinic revenue grew 28% on an adjusted pro forma basis. Our Regional Account Manager program is building awareness among referring providers and helping more patients find relief from their depression in our clinics. In the fourth quarter, our referring provider network added 430 new providers, a 25% increase year over year, contributing to over 1,300 new referrers added across 2025. This growth was supported by significantly higher field engagement, with our regional teams completing more than 47,000 physician outreach activities during the year. These efforts drove over 2,300 patient referrals in Q4, representing a 46% increase over the prior-year period. Our automated patient transfer process, educational tools, scheduling QR codes, and coordinated intake team engage patients while they are still at the primary care doctor's office. These capabilities are improving referral-to-treatment conversion while reducing friction for both the provider and the patient across the Greenbrook network. We are nearly complete with our SPRAVATO rollout, with 84 clinics now providing the treatment. Throughout 2025, we optimized our billing practices based on the economics of buy-and-bill versus administer-and-observe, and we have taken a disciplined approach to deploying the right billing model by state, by payer, and by clinic. Our efforts across both SPRAVATO and TMS continue to drive strong results, with total treatment volume up 18% year over year in the fourth quarter. On the operational side, we continue to drive standardization across the network, focused on getting patients into treatment faster and simplifying their experience at our clinics. We deployed tablet kiosks across all locations, streamlining check-in and making it simple for a patient to remit their patient-responsibility payments at the time of the visit. We are also piloting a patient portal that allows patients to complete intake forms and submit insurance information before their appointment, with the goal of offering an all-digital intake pathway in the future. We are starting to leverage AI in our benefits investigation, with initial applications helping us file claims faster and more accurately, increasing first-pass acceptance rates while reducing labor. Collectively, these efforts are enabling our team to care for more patients daily while improving our cash conversion. Turning to our NeuroStar business and the BMP program. On the system side, we had a strong finish to the year, shipping 49 systems in the quarter at an average selling price above our target for the fourth consecutive quarter. That tells us customers continue to see the value in NeuroStar and in the support that comes with it. As we have discussed throughout the year, we made a deliberate decision to realign our capital team towards higher-volume, higher-growth accounts that could add NeuroStar TMS into their practices quickly, meaning that they have the staff available to incorporate TMS into their practice, are credentialed with insurance payers, and therefore can get up and running treating patients faster. With that focus on TMS-ready accounts, we are seeing the benefits in system ASP, a reduction in resources needed to go from purchase to treatment of the first patient, and in the quality of accounts we are adding to the network. We believe this positions our NeuroStar business well heading into 2026, and I will discuss more about that shortly. On a pro forma basis, treatment session revenue increased 6% in Q4 on strong treatment utilization growth of 11%. Our Better Me Provider program had over 420 active sites at the end of 2025, with nearly 100 additional sites working towards qualification. Since inception, the program has connected more than 66,000 patients interested in NeuroStar TMS with one of our Better Me Providers. BMP sites continue to deliver significantly higher patient volumes and faster response times than nonparticipating sites, and we have observed that treatment session utilization is increasing at these sites, indicating strong patient flow and demand for existing equipment. We also continue to see growing recognition of NeuroStar TMS as a treatment option for adolescents. During the quarter, TRICARE West expanded coverage for TMS therapy to include adolescents age 15 and older diagnosed with depression, and the coverage is effective across 26 states. That is a meaningful development for military families and further validates the expanding insurance landscape for adolescent TMS treatment. Moving on to our Provider Connection program, which we launched last April. The program has gained real traction. Our field team has held over 400 educational meetings resulting in more than 210 new referral sites by year end. We have also seen strong engagement through the directed provider campaigns and the inside sales outreach efforts. This program takes what we have learned at Greenbrook about educating primary care physicians on the benefits of NeuroStar TMS and applies it across our entire NeuroStar customer base, and it is becoming a meaningful part of how we help patients find and access care with NeuroStar providers. We are also leveraging our Greenbrook infrastructure to offer new services to our NeuroStar customers. Through our intake center, we are now providing benefits investigations and patient management support to partners like Transformations Care Network and Elite DNA. Our benefits investigation model delivers financial clarity to patients within 24 hours, helping practices accelerate patient decision-making, and our patient management program guides patients from initial interest through to treatment, ensuring seamless engagement at every step. These programs are already driving new patient starts at our partner sites and represent a scalable model that we can extend across our national enterprise accounts. Stepping back, I want to put this year into context. When we announced the Greenbrook acquisition, we laid out a thesis that combining NeuroStar's technology platform and training programs with the Greenbrook National Care Delivery Network, we would expand patient access, accelerate growth, and create a path to profitability. One year in, that thesis is playing out. We grew revenue, we reached positive operating cash flow, we strengthened our balance sheet, and we built a platform that is now enabling opportunities that neither company could have pursued on its own. I will now turn it over to Steve to take you through the financial details, and then I will come back to talk about what those opportunities look like heading into 2026.

Thank you, Keith. Good morning, everyone. Unless otherwise noted, all performance comparisons are being made for 2025 versus 2024. Total revenue in the fourth quarter was $41.8 million, an increase of 86% compared to revenue of $22.5 million in 2024, primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, fourth quarter revenue increased 23% versus the prior year. Total revenue from our NeuroStar business, inclusive of our system revenue as well as treatment session revenue, was $18.3 million in 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents an increase of 9% versus the prior year. U.S. NeuroStar system revenue was $4.4 million, an increase of 15% on a year-over-year pro forma basis, and we shipped 49 systems in the quarter. This compares favorably to our fourth quarter 2024 shipments of 46 units, and we continue to see strong system ASP in the quarter. U.S. treatment session revenue was $12.4 million. On a pro forma basis, treatment session revenue increased 6% compared to the prior-year quarter. The reported decline of 4% is primarily attributable to the absence of prior-year Greenbrook intercompany purchases. Clinic revenue was $23.5 million for the three months ended 12/31/2025, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and SPRAVATO treatments. Gross margin was 52% in 2025 compared to 66% in the prior-year quarter. The decrease was due to the inclusion of Greenbrook's clinic business, which operates at a lower margin. It is worth noting that Q4 gross margin was our highest quarterly margin of the year, reflecting the impact of our efficiency efforts within the Greenbrook clinics as well as favorable product mix. Operating expenses during the quarter were $26.7 million, an increase of $0.4 million, or approximately 1.4%, compared to $26.4 million in 2024. The increase was primarily attributable to the inclusion of Greenbrook's general and administrative expenses of $8.5 million, partially offset by a reduction of R&D expenses. During the quarter, we incurred approximately $2.2 million of non-cash stock-based expense. Net loss for the quarter was $7.2 million, or $0.10 per share, as compared to a net loss of $12.7 million, or $0.34 per share, in the prior-year quarter. Fourth quarter 2025 EBITDA was negative $4.3 million, as compared to negative $11.0 million in the prior year. Moving to the balance sheet and cash flow. As of 12/31/2025, total cash was $34.1 million, consisting of cash and cash equivalents of $28.1 million and restricted cash of $6.0 million. This compares to total cash of $19.5 million as of 12/31/2024. Cash provided by operations in the fourth quarter was a positive $0.9 million, representing a continuation of the steady improvement we delivered throughout 2025. To put this in context, our operating cash burn improved sequentially every quarter this year from negative $17.0 million in Q1 to positive $0.9 million in Q4. This progress reflects the compounding effect of our continued revenue growth, expense discipline, revenue cycle management improvements, and operational efficiencies across the business. In March 2026, we amended our debt agreement with Perceptive, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a one-time principal payment of $5.0 million to Perceptive, along with adjustments to the existing covenants. Now turning to guidance. For the full year 2026, we expect total revenue of between $160 million and $166 million, with the midpoint of that range representing greater than 9% growth versus 2025. We expect to see strong revenue performance in our clinic business, with growth year over year in the double digits to mid-teens. For the NeuroStar business, we see increased momentum driving revenue growth year over year in the low to mid-single digits. For the first quarter 2026, we project revenue of between $33 million and $35 million. We expect full-year gross margin to be between 47% and 49%. This reflects the impact of efficiency efforts within our clinic network as well as product mix associated with higher clinic revenue growth. As we drive revenue growth, we remain highly focused on operating efficiency. We expect operating expenses of between $100 million and $105 million for the full year, inclusive of approximately $8.5 million of non-cash stock-based compensation. This total includes investments and costs associated with efficiency efforts primarily in 2026. We expect to see the full benefit of these efforts by the end of the third quarter, with operating expenses at an annualized run rate of less than $100 million by the fourth quarter 2026. For the full year 2026, we expect cash flow from operations to be between negative $13 million and negative $17 million. This includes the necessary investments in efficiency, particularly in 2026, to continue our efforts to drive towards sustainable operating cash flow. Similar to last year, we expect our operating cash burn will be highest in the first quarter due to seasonality of both businesses, where we typically see our lowest patient volumes and lowest capital revenues. Additionally, the first quarter is when we see higher annual cash outlays, such as licenses and incentive compensation. Operating cash flow is projected to improve significantly beginning in the second quarter and then sequentially through the remainder of the year, with operating cash flow being positive during the second half of the year. I will now turn it back to Keith for his closing remarks.

Thank you, Steve. I would now like to spend a few minutes on multiple meaningful opportunities ahead of us in 2026. We have spent the last year proving that our integrated model works. We now have a national platform with over 420 BMP accounts and Greenbrook locations across 49 states, a proven playbook for launching therapies in clinic-based settings, deep relationships with primary care physicians, and an infrastructure that gets stronger with every patient we treat. As we move into 2026, we are focused on leveraging that platform to drive the next phase of growth through two key initiatives. First, we are expanding how we bring NeuroStar TMS systems to market. As we continue to analyze the TMS market, we have determined that different customers want to acquire access to our technology in different ways. We are piloting new models to meet these customers' needs, allowing them to utilize NeuroStar TMS in a way that works best for them. We are testing these approaches during the first quarter and will provide updates throughout the year on their progress. We have expanded our capital sales team to help target and capture these opportunities. Second, we will continue to see strong growth in demand for depression treatment at our Greenbrook clinics. We now know that a significant unmet need remains. There are approximately 4 million patients with treatment-resistant depression, or TRD, in the United States, and individuals who have failed two or more antidepressants have limited effective options. NeuroStar TMS and SPRAVATO are both important therapies for many of these patients, but the vast majority of the TRD population remains undertreated, and we believe new therapy options can help us reach more of these patients. That is why we are excited to continue to advance our collaboration with COMPASS Pathways on COMP360 psilocybin, a potentially transformational new treatment for TRD. We believe that this could represent one of the most meaningful developments in mental health treatments in decades. COMPASS has recently completed two Phase 3 studies demonstrating highly statistically significant and clinically meaningful results, including durable improvement through at least 26 weeks after just one or two doses. COMPASS plans to submit an NDA, with the potential for an FDA decision by year end. Our Greenbrook clinics are uniquely positioned to be the leader in offering new therapies like this. We already serve a large TRD population across our network, and we believe a new FDA-approved option has the potential to drive increased awareness and engagement from both patients and referring providers. Through our experience integrating and scaling SPRAVATO across the Greenbrook network, we have built a proven playbook for launching REMS-compliant therapies, those requiring enhanced safety protocols and administration in clinic-based settings. We have a national footprint, experienced staff, and an operational infrastructure to support a launch, and because of the alignment with our existing SPRAVATO operations, we expect only limited incremental investment to support this new modality, if approved. Through our existing collaboration with COMPASS, we are preparing to commercially offer this treatment upon an FDA approval. We have identified the initial centers for the rollout, and we are working closely with COMPASS to align launch plans and to support the establishment of favorable coverage policies with payers. We see this as a natural extension of what we have built, further expanding Greenbrook's care platform to deliver innovative treatments to patients who need them most. Beyond treatment-resistant depression, we are also excited about the broader promise of psychedelic-class treatments, which have the potential to help patients suffering from PTSD, generalized anxiety disorder, and other serious conditions. We want Greenbrook to be the platform that can serve all these patients, and our track record of launching and scaling treatments across a national clinic network gives us confidence that we can deliver on that vision. We are excited to share more as we get closer to the potential launch in 2027. Before we open for questions, I want to take a moment to reflect on my time at Neuronetics, Inc. When I joined over five years ago, we were a single-product company with a bold vision. Today, we are a vertically integrated mental health platform with a national clinic network, a growing base of committed NeuroStar providers, and a pipeline of potential new treatment modalities on the horizon. None of that happens without this team. The people at Neuronetics, Inc. and across the Greenbrook clinics show up every day with a commitment to patients. I am proud of what we have built together, and I am proud of the difference we are making in the lives of patients and providers across the country. I leave this company in a position of strength and in very capable hands with Dan. I believe the best is truly ahead for Neuronetics, Inc. With that, I would like to turn the call over to the operator for questions.

Thank you. To withdraw your question, please press 11 again. We will now open for questions. Our first question is from William John Plovanic with Canaccord. Your line is now open.

Hey, great. Thanks. Good morning, and thanks for taking my question. So first of all, Keith, congratulations on your retirement, on significant transformation of a business. I think this was $50-ish million in revenues when you took over five years ago, and just adding Greenbrook and the scale and finally hitting that targeted cash flow positive, you know, it is definitely a hard-fought battle, but one, and congratulations. I have three questions. One of them is simple. So just, you know, one, I am going to start with the tough one. Just any granularity, color you can provide on the CID in Florida and this Michigan and what documents they are really asking for, and is this related to Greenbrook?

Bill, that is an investigation that is ongoing at the moment. What we can say about it is that we are providing all of the information to the U.S. Attorney's Office in the Middle District of Florida. They have requested documentation for billing practices prior to the acquisition of our acquisition of Greenbrook, and we are cooperating fully with them.

Okay. Thank you. And then just secondly, on this SPRAVATO, thanks for the update. You know, on the COMP360, just if you could give us any feeling for difference in time the patients have to be in the facility post-treatment or delivery of medication, and then, you know, any difference in the profitability. Like, is it going to be shorter and more profitable, or the patient hangs out longer and it is less profitable per hour, per minute, whatever way you metric you look at. How do we think about that as that rolls out?

Bill, we have asked Corey Anderson, who is our Chief Technology Officer and running the Greenbrook side of the business, to join us today. So I am going to let him answer that question for you.

Good morning, Bill, and thank you for the question. So COMP360 is administered in supervised doses within the clinic setting, so there is not a daily or recurring protocol. Unlike these daily medications, the treatment effect appears to be durable after just one or two administrations. So if it is approved, COMP360 would be administered under a REMS protocol requiring certified health care settings, trained staff, and patient monitoring, very similar to what we are currently doing with SPRAVATO.

Yeah, Bill, this is Steve. Just to add, you asked about the economics. We are working closely with COMPASS to look at reimbursement and understand that as we get closer to launch. So more to come on that piece, but I would view it similar to how we have looked at SPRAVATO A and O and SPRAVATO B and B. You know, if the reimbursement is there, it is a great business, but we are not going to take on business that is not going to be profitable at the end of the day. I think COMPASS is working hard, and we are working hand in hand with them to make sure we have got adequate reimbursement to make this a profitable business.

Great. And then last question, Steve, is you ended the year with $34.1 million, $6.0 million was restricted. Now you paid down $5.0 million to Perceptive. Did that $5.0 million come out of the restricted or the non-restricted? And how do you feel about the cash position given the projected Q1 cash burn?

Yeah. So it does not come out of the restricted piece. So if you looked at 2025, we had $34 million. If you take that $5 million off, it would be a pro forma cash balance of $29 million. If you look at the midpoint of our operating cash flow guidance, we would still have, call it, $14 million to $15 million of cash at year end, obviously some of that being restricted, but that is a cash balance that we have been comfortable with, especially as we are focused on efficiency, reducing overall expenses, and profitability, especially in the second half of this year. I think the other benefit of paying that down is we get interest expense reduction from that. We are probably going to save close to $600,000 annually just for that $5 million paydown, and it just optimizes that overall debt balance that we have out there. So net-net, we are comfortable with where we sit, and I think it continues reducing that operating cash flow burden by taking out some interest.

Great. Thanks for taking my questions.

Thank you. Our next question is from Adam Maeder with Piper Sandler. Your line is open.

Hi. Good morning, Keith and Steve. And, Keith, wishing you all the best in the next chapter. A couple of questions from me. I guess I wanted to start on the guidance front and just double click on the 7% to 11% top-line guidance for the overall business. If I heard correctly, double digits to mid-teens growth for the clinic, low to mid-single-digit growth for standalone. Can you just help us understand within the clinic how much is coming from SPRAVATO, and then on the NeuroStar or standalone side of things, volume versus capital? And then I had a couple of follow-ups.

Yeah, thanks, Adam. I will give a little bit of commentary on that. On the clinic side, we expect the majority of the growth to come from the volume side of it, although in Q1, in particular, we will have a lot of SPRAVATO growth due to BNB. So as you recall, we really did not have buy-and-bill volume in 2024, and it was actually pretty limited in Q1 of this past year. In fact, we kind of stabilized more in Q2 of last year at about one out of every seven SPRAVATO treatments being buy-and-bill, but prior to that, in Q1, it was still very limited. So I think what you will see on the growth is Q1 driven by that SPRAVATO BNB impact. Once we get into Q2, it is annualizing, and from that point forward, really, it is about just volume growth overall. SPRAVATO growth, I think, will be volume growth that will be higher than in TMS in general, but we have not broken out that growth rate. Maybe just to give you a flavor, SPRAVATO was probably 30% of our treatment at the start of 2025. It was about 35% by year end 2025. I would expect to see that pattern continue of SPRAVATO representing more of that treatment volume on a quarter-over-quarter basis throughout 2026. It is just a significant growth. I think the thing to remember about SPRAVATO in particular is once you start a patient and they respond, they stay on maintenance therapy long term, whereas with TMS, it is a course of 36 treatments, they are done, and they will come back only if they need to. So it is a little different cadence of how those patients build over time, but SPRAVATO certainly has that continuing maintenance therapy that patients stay on long term. On the NeuroStar side, to give a little bit of color there, Keith mentioned that we do have additional capital reps. We have been generally at around 40 capital shipments a quarter, a little less in Q1, a little higher in Q4. We would expect that to increase to as much as 45 or more as their impact is felt over time. So I think it will take a little bit of time for those reps to get up and running, and then the guidance we gave really, because our treatment session is just the biggest segment of the business, we would expect growth there to largely match the overall guidance of what we gave for the NeuroStar side of the business.

That is great color. Appreciate that, Steve. And for the follow-up, I actually wanted to ask about Q1 guidance. The Street was a little bit higher than where you have guided to for the first quarter, maybe some mismodeling on our part. But can you just talk about the trends in the business quarter to date? And are you seeing anything that has maybe deviated from past trends? I would just love some incremental color for the first couple of months of the year.

Thanks. I will give a couple of comments there. Certainly, one is we are still just over a year into the Greenbrook acquisition. A big piece of what we have come to understand is that there is seasonality in the business itself, and we find in November and December we see new starts come down on the clinic side of the business. That is just holiday impact. So that kind of works its way through the first part of Q1 here. We tend to have a little bit of that negative seasonality impacting us in Q1. If you look at the overall level of revenue, clinic seasonality is meaningful. It is not uncommon for us to see a huge swing between Q1 and Q4. That is a big piece of that. I would say seasonality also impacts us on the NeuroStar side of the business, especially when you think about capital. Capital is always lighter in Q1 versus Q4. That has to do with how capital budgets are planned in clinics and at our customers. Generally, they are using it in Q4 and using less of it in Q1. Depending on how you look at that, those are two big seasonality impacts. I think the other thing that has really been an impact here, especially over the last couple of months, we have had some weather impacts, which affects patients being able to get in the clinic. We are going to have some of that every winter, but that is obviously something we have to manage as we think about January, February, March, and some of the storms we have had. So that bleeds into the seasonality that we generally see as we go from Q1, which, again, is always our lowest revenue quarter of the year, to Q4, which is generally the highest.

That is helpful. Thanks. I will jump back in the queue.

Thank you. Our final question is from Daniel Walker Stauder with Citizens. Your line is now open.

Yeah, great. Thanks for the questions. Just first off, Keith, congratulations on a great run. It has been great working with you. So I am sending my congrats and just reiterating everyone else's comments. I guess, first, on the COMPASS collaboration, you know, that is really positive news, and I know we have talked a bit about this new wave of therapeutics and the potential role Neuronetics, Inc. could play here, but I was hoping you could give us any more color on this agreement specifically. It sounds like you will be the preferred provider, but is there any exclusivity involved at this point? And if not, could there be in the future? Thanks.

Yeah, thanks for the question. So, you know, Greenbrook has been working with COMPASS over the past three years, and we have continued to advance that collaboration to help them with their preparations for commercial launch. We anticipate through the course of this year we will have continued discussions about our preparations as an organization to launch the therapy. As you are probably aware, our CMO, Dr. Jeff Grammer, participated in a COMPASS-hosted webinar in January, and we have laid out our operating plans to be prepared for the launch next year. As to the point of exclusivity, COMPASS has about seven of these strategic collaborations to help them prepare for commercial readiness, and Greenbrook is one of them.

Great. Appreciate it. And just following up on that, staying with COMPASS, you know, it sounds like there should not be too much more of a lift, but, you know, beyond having to update some of your workflow maybe, are there any other updates you need to make, such as personnel or anything physical to your clinics? I am really just trying to get more of an appreciation of how seamlessly this could integrate into the current infrastructure you have. Thank you.

Yeah. So, as you are aware, we operate about 84 SPRAVATO clinics under this REMS framework across the country, and I think our infrastructure and experience in running these SPRAVATO clinics provides three key advantages for Greenbrook. First, our clinical staff is experienced in both administering and monitoring these patients under treatment. Second, we have a significant infrastructure and investment in the back-office support of benefits investigations, prior authorizations, and ultimately helping patients access care. And third, we have a deep network of referring providers, psychiatrists, primary care doctors, and others that refer their patients to Greenbrook for these treatments. So I think the infrastructure is largely there, and we will be able to provide COMP360 treatments within the clinics and with the staff already in place at Greenbrook.

Appreciate that. Just one final one from me on the SPRAVATO rollout. It sounds like you are nearly complete with all the 89 sites, but I just wanted to ask on the utilization of SPRAVATO for these newer converted clinics. How quickly has this ramped once it is available? Is it weeks, months, quarters? Just trying to get a sense of some of these utilization trends. Thank you.

We look at our utilization, our marketing, and our conversion rates on a daily basis. We are able to identify where we need to add SPRAVATO and where we do not. So in the five locations that are remaining, we are building up that marketing presence there to be able to hit the ground running. We are very comfortable with each one of our locations generating SPRAVATO at the proper level and with the proper billing process, either buy-and-bill or administer-and-observe.

Great. Appreciate it, guys. Thank you.

Thank you. I would now like to turn the call back over to Keith for closing remarks.

Thank you, operator. Thank you all for your interest in Neuronetics, Inc. I really appreciate your support over the last five and a half years while I have been here. It has been a pleasure working with our three analysts and all of the investors. I look forward to hearing the updates on the Q1 call and getting you updated at that point. Thank you all.

This concludes today's conference call. Thank you for participating, and you may now disconnect.